DESCRIPTION (APPLICATION ABSTRACT): The executive summary of the National Health Care Quality report states that the quality of healthcare offered in the United States "falls far short of what it should be." The report noted the gap between the services that should be provided and those that should be received. This proposal responds to that chasm and seeks support for a project that will examine the relationship between working conditions and the quality of care provided in rural hospitals. This proposal is closely aligned with two other federal initiatives, the Institute of Medicine's Report To Err is Human and Envisioning National Health Care Quality Report. We propose a three year multi-method, intervention study that would specifically improve patient safety and encourage the disclosure and reduction of error in rural health care settings by: * exploring the relationship between the organizational factors that directly influence the rural healthcare provider, the delivery of patient care, and the identification, discussion and disclosure of medical errors, near misses, and adverse events; * using the data from all research studies to increase patient safety by developing and implementing a web based intervention in the form of a curriculum that is accessible to healthcare providers in rural hospitals and designed to raise awareness, encourage reporting, and build skills to address adverse events; *assessing the impact of interventions on the safety and quality of patient care in rural hospitals. This project is designed to respond to rural needs and improve the quality and safety of rural healthcare. In addition, it will provide data that identifies best practices for error reduction in rural healthcare settings. The intervention will target interdisciplinary teams of rural healthcare providers, and hospital staff across 30 hospital settings in an area of the rural west.